摘要: 目的：系统评估家庭环境特征、父母养育方式及围产期相关因素与儿童抽动障碍(TD)发病的关联强度，探讨各因素在疾病发生中的相对作用，为构建TD的多维病因模型及制定早期干预策略提供实证依据。方法：采用病例对照研究设计，选取2023年9月至2025年6月于成都西南康复医院发育行为科就诊的TD患儿180例为病例组，同期来自社区学校的健康儿童180例为对照组。采用家庭环境量表中文版(FES-CV)、父母养育方式评价量表(EMBU)、自编围产期情况调查表及一般资料问卷进行评估。运用SPSS 27.0进行单因素分析和多因素非条件Logistic回归分析。结果：单因素分析显示，男性(OR = 2.43, 95% CI: 1.58~3.74)、TD家族史(OR = 5.67, 95% CI: 2.89~11.12)、单亲家庭(OR = 3.21, 95% CI: 1.67~6.18)、家庭矛盾性高(OR = 2.89, 95% CI: 1.76~4.74)、家庭亲密度低(OR = 2.34, 95% CI: 1.43~3.83)、父亲情感温暖低(OR = 2.11, 95% CI: 1.29~3.45)、母亲拒绝否认高(OR = 2.78, 95% CI: 1.70~4.55)、孕期情绪不良(OR = 3.45, 95% CI: 2.10~5.67)、出生窒息史(OR = 4.12, 95% CI: 2.23~7.61)、孕期止吐药暴露(OR = 5.23, 95% CI: 1.98~13.81)及严厉打骂体罚教育方式(OR = 3.57, 95% CI: 1.52~8.34)与TD发病显著相关。多因素回归分析最终进入模型的独立危险因素为：TD家族史(OR = 4.86, 95% CI: 2.98~7.93)、家庭矛盾性高/家庭不和睦(OR = 2.56, 95% CI: 1.48~4.43)、孕期情绪异常(OR = 2.50, 95% CI: 1.78~3.52)、围产期不利因素(OR = 3.05, 95% CI: 2.21~4.21)、母亲拒绝否认养育方式(OR = 2.34, 95% CI: 1.35~4.05)及严厉打骂体罚教育方式(OR = 2.78, 95% CI: 1.73~4.47)。结论：儿童TD发病是遗传易感性、围产期生物学应激与家庭心理社会环境多因素交互作用的结果。遗传因素奠定疾病基础，围产期不良暴露构成“第一次打击”，而不良家庭环境与负性养育方式作为“第二次打击”促成疾病的临床表达。研究提示，针对高危家庭的早期心理行为干预及围产期保健优化可能对TD的预防和预后改善具有积极意义。
Abstract: Objective: To systematically evaluate the associations between family environment characteristics, parental rearing patterns, perinatal factors, and the onset of tic disorder (TD) in children, and to explore the relative contributions of these factors to disease occurrence, thereby providing empirical evidence for a multidimensional etiological model of TD and early intervention strategies. Methods: A case-control study design was employed. A total of 180 children diagnosed with TD at the Department of Developmental Behavior, Chengdu Southwest Rehabilitation Hospital between September 2023 and June 2025 were enrolled as the case group, and 180 age- and sex-matched healthy children from community schools were enrolled as the control group. All participants were assessed using the Family Environment Scale-Chinese Version (FES-CV), the Egna Minnen av Barndoms Uppfostran (EMBU) Chinese Revision, a self-designed Perinatal Factors Questionnaire, and a general demographic information form. Univariate analyses and multivariate non-conditional logistic regression were performed using SPSS 27.0. Results: Univariate analysis revealed that male sex (OR = 2.43, 95% CI: 1.58~3.74), family history of TD (OR = 5.67, 95% CI: 2.89~11.12), single-parent family (OR = 3.21, 95% CI: 1.67~6.18), high family conflict (OR = 2.89, 95% CI: 1.76~4.74), low family cohesion (OR = 2.34, 95% CI: 1.43~3.83), low paternal emotional warmth (OR = 2.11, 95% CI: 1.29~3.45), high maternal rejection (OR = 2.78, 95% CI: 1.70~4.55), maternal emotional distress during pregnancy (OR = 3.45, 95% CI: 2.10~5.67), history of birth asphyxia (OR = 4.12, 95% CI: 2.23~7.61), and harsh punitive parenting (OR = 3.57, 95% CI: 1.52~8.34) were significantly associated with TD. Multivariate logistic regression identified the following independent risk factors: family history of TD (OR = 4.86, 95% CI: 2.98~7.93), high family conflict/disharmony (OR = 2.56, 95% CI: 1.48~4.43), maternal emotional distress during pregnancy (OR = 2.50, 95% CI: 1.78~3.52), perinatal adverse factors (OR = 3.05, 95% CI: 2.21~4.21), maternal rejection (OR = 2.34, 95% CI: 1.35~4.05), and harsh punitive parenting (OR = 2.78, 95% CI: 1.73~4.47). Conclusion: Childhood TD arises from the complex interaction of genetic susceptibility, perinatal biological stress, and family psychosocial environment. Genetic factors establish the disease predisposition, perinatal adverse exposures constitute the “first hit,” and unfavorable family environment with negative parenting styles serve as the “second hit” that triggers clinical expression. These findings suggest that early psychosocial interventions targeting high-risk families and optimization of perinatal care may have positive implications for TD prevention and prognosis improvement.